First-line antiretroviral therapy and dyslipidemia in people living with HIV-1 in Cameroon: a cross-sectional study

Abstract

BackgroundData on lipid profile derangements induced by antiretroviral treatment in Africa are scarce. The aim of this study was to determine the prevalence and characteristics of lipid profile derangements associated with first-line highly active antiretroviral therapy (ART) among Cameroonians living with human immunodeficiency virus (HIV) infection.MethodsThis cross-sectional study was conducted between November 2009 and January 2010, and involved 138 HIV patients who had never received ART (ART-naive group) and 138 others treated for at least 12 months with first line triple ART regimens that included nevirapine or efavirenz (ART group). Lipid profile was determined after overnight fast and dyslipidemia diagnosed according to the US National Cholesterol Education Program III criteria. Data comparison used chi-square test, Student t-test and logistic regressions.ResultsThe prevalence of total cholesterol ≥ 200 mg/dl was 37.6% and 24.6% respectively in ART group and ART-naive groups (p = 0.019). The equivalents for LDL-cholesterol ≥ 130 mg/dl were 46.4% and 21% (p ≤ 0.001). Proportions of patients with total cholesterol/HDL-cholesterol ratio ≥ 5 was 35.5% in ART group and 18.6% in ART-naive group (p ≤ 0.001). The distribution of HDL-cholesterol and triglycerides was similar between the two groups. In multivariable analysis adjusted for age, sex, body mass index, CD4 count and co-infection with tuberculosis, being on ART was significantly and positively associated with raised total cholesterol, LDL-cholesterol and TC/HDL cholesterol. The adjusted odd ratios (95% confidence interval, p-value) ART-treated vs. ART-naïve was 1.82 (1.06-1.12, p = 0.02) for TC ≥ 200 mg/dl; 2.99 (1.74-5.15), p < 0.0001) for LDL-cholesterol ≥ 130 mg/dl and 1.73 (1.04-2.89, p = 0.03) for TC/HDL-cholesterol ≥ 5.ConclusionsFirst-line antiretroviral therapy that includes nonnucleoside reverse transcriptase inhibitors is associated with pro-atherogenic adverse lipid profile in people with HIV-1 infection compared to untreated HIV-infected subjects in Yaounde. Lipid profile and other cardiovascular risk factors should be monitored in patients on such therapy so that any untoward effects of treatments can be optimally managed.

Hypertension and Related Risk Factors among Clients on Combined Antiretroviral Therapy in Nigeria

“…The hypertension occurrence was considerably greater in patients on cART as compared to cART-naïve patients. This observation corroborates with previous studies of Lichtenstein et al [15], Pefura Yone et al [16], Ekali et al [17], Muhammad et al [11] and Njelekela et al [18], which revealed a higher incidence of hypertension in patients on cART. Contrarily, the findings of other studies of Agrawal et al [19] indicated no disparity in the prevalence of hypertension between patients on cART and cARTnaïve patients.…”

Comparison of Serum Lipid Profile in HIV Positive Patients on ART with ART Naïve Patients

“…There are suggestions that the magnitude of first-line ART-induced lipid derangements could vary across populations and settings. Based on LDL-C cut-off values, the prevalence rate of dyslipidemia in our study (48%) was higher than that reported in Cameroon (46.4%) [16], Western India (30%) [10] and Uganda (6%) [17]. But the prevalence of high LDL-C prior to ART (5%) was almost same as reported in Uganda and Western India (4%) [10,17], but less than that reported in Cameroon (21%) [16].…”

“…There was no significant difference in HDL-C levels between these groups. The proportion of patients with dyslipidaemia among our ART treated participants was higher than the rate reported in a study from Cameroon and rural Uganda [16,17]. There are suggestions that the magnitude of first-line ART-induced lipid derangements could vary across populations and settings.…”

“…But the prevalence of high LDL-C prior to ART (5%) was almost same as reported in Uganda and Western India (4%) [10,17], but less than that reported in Cameroon (21%) [16]. Similar to the Cameroon study [16], our study showed no changes in HDL-C levels after ART, which is not in accordance with the findings in Western India [10], which showed significant increase in HDL-C after 18 months of treatment with first-line ART regimen.…”

Change in serum lipid profiles and glucose after switching from stavudine/lamivudine to zidovudine/lamivudine in non-nucleoside reverse transcriptase inhibitors based anti-retroviral regimens in Southern Ethiopia

“…In both models, sex was a significantly and negatively associated risk factor for raised TC and TGs; but the findings are not in line with the cross-sectional study conducted in Cameroon (Pefura Yone et al, 2011). Antiretroviral-specific risk factors for glucose abnormalities include the exposure to PIs and to certain NRTIs.…”